The Centers for Medicare & Medicaid Services (CMS) have embarked on a decisive move by enforcing a standard for Advancing prior authorization. In a conversation with the Senior Director of Utilization Management, we discussed the potential implementation and impact of this proposed mandate, slated for enactment in January 2026 The Predicament of Prior Authorization The […]
From the inception to the conclusion of the Revenue Cycle Management (RCM) pipeline, it is imperative for practices to implement enhanced analytics and streamlined workflows. Healthcare providers have grappled with the challenge of receiving proper compensation for their services, and the current reimbursement landscape presents even greater obstacles compared to previous years. Payors are persistently […]
The principal of a healthtech venture capital firm asserts that the most promising AI innovation from an investment standpoint involves rendering business models feasible. Investment focus has now shifted towards AI for a healthtech and medtech venture capital firm, which administers a capital pool exceeding $800 million earmarked for healthcare and technology startups. The healthtech […]
In the coming decade, physicians and patients will grapple with intertwined challenges. A mounting need for physicians, projected to face a shortage of up to 124,000 professionals, coincides with evolving patient expectations favoring seamless digital interactions. How can medical practices navigate heightened patient demands amidst a diminishing workforce? Drawing from my experience collaborating with numerous […]
To ensure both financial stability and operational efficiency, revenue cycle leaders must reinforce three essential areas. The challenges of grappling with low operating margins, diminished reimbursements, and escalating costs will persist throughout 2024. In an era where a subpar financial journey could overshadow a top-tier clinical experience for patients, the burden on revenue cycle leaders […]
Ensuring precise claims processing and prompt reimbursements, healthcare practitioners rely heavily on efficient medical billing and coding procedures. The act of streamlining these functions holds the potential to not only heighten overall effectiveness but also to curtail administrative burdens and mitigate the risk of errors. Within this article, we will delve into a selection of […]
The healthcare industry is constantly evolving, and with it, so are the processes and procedures that are involved in billing and coding. As we move towards a more digital and technology-driven world, it’s important for healthcare professionals to stay up-to-date with the latest trends and changes in the industry. In this blog post, we’ll explore […]
Revenue cycle technology comes in various forms, tailored to the specific needs of healthcare providers, yet these indispensable tools have become vital for ensuring seamless operations within the revenue cycle. The healthcare revenue cycle represents a vast and intricate operation that encompasses a range of activities, from patient registration and insurance verification to denials management […]
As healthcare providers, ensuring that your accounts receivable (A/R) is properly managed is crucial to the financial health of your practice. However, managing healthcare A/R can be a daunting task, especially when it comes to follow-up on denied claims. In this ultimate guide, we’ll provide you with best practices to effectively manage your healthcare A/R […]
Medical coding and medical billing are two distinct yet interrelated tasks in the healthcare industry. Coding is the process of assigning standardized codes to diagnoses and procedures, while billing is the process of submitting claims to insurance companies for reimbursement. One of the biggest challenges in the medical billing space today is the shortage of […]